Managing
symptoms

The person you’re caring for may have certain symptoms or side effects. There are lots of ways that you can help them manage these.

People with advanced cancer sometimes have a sore mouth. Using soft toothbrushes and mouth rinses might help. They may also feel sick, or have difficulty chewing or swallowing. You could try giving them small meals throughout the day or softer food. They might also take longer to eat or prefer to eat alone.

People who have advanced cancer are more likely to become constipated. If they have constipation, you could ask the GP for advice. The GP might suggest they drink lots of fluids, or recommend laxatives, suppositories or enemas.

If the person you’re caring for has pain, they may already have been prescribed painkillers. If the painkillers don’t seem to be working, talk to the GP. You could help with simple things like ice packs or massage.

Sleeping problems are also common. Your GP might need to adjust any medication. You could help by making sure that the person’s bedroom is comfortable.

Sore mouth

A sore mouth is a common side effect of cancer treatment or the effects of advanced cancer. It can make someone feel very unwell and uncomfortable.

If your relative or friend's mouth is too sore to use an ordinary toothpaste and toothbrush, try using a soft toothbrush and mouth rinses. If their lips are dry, a lip balm can be useful.

Mouth ulcers and thrush are common. If their mouth becomes very sore or coated, tell the GP, specialist palliative care team or district nurse. It is very important these symptoms are treated. There are mouthwashes, tablets, gels or pellets that can help relieve the symptoms. If dental treatment is needed, ask the dentist if they can do a home visit. You may need to pay for this.

Constipation

People who have advanced cancer are more likely to become constipated. There are various reasons for this. Some people get constipated because they have lost their appetite and aren’t eating enough, or because they can’t move around much.

Painkillers can cause constipation and if they are being taken regularly, laxatives may be necessary. A laxative is a medicine that helps people go to the toilet. The GP can prescribe suitable laxatives.

If the person you are caring for has constipation, tell the GP, district nurse or palliative care nurse. They will probably suggest that the person increases the amount of fluids they drink and may recommend laxatives, suppositories or enemas. These should help relieve the constipation.

If the person you are caring for has no problems with eating, then it’s helpful to add more fruit and high-fibre foods to their diet.

A poor appetite and eating difficulties

People who are very ill often don’t feel like eating. Cancer, its treatments and medicines can all affect appetite. Feeling sick and having diarrhoea or constipation can stop them eating. They may feel too tired to eat, have a sore or dry throat or mouth, or find chewing and swallowing difficult.

Cancer can change the way the body uses food, so it’s possible to lose weight even if they are eating normally. If your relative or friend is having trouble eating, it may help to ask the GP or district nurse for advice, or ask to speak to a dietitian.

The amount they can eat may change from day to day and their likes and dislikes may also change. Take time to ask them what they’d like to eat. Try to give them small meals often, whenever the person feels like eating, rather than at set times of the day. Small meals and snacks can also help if the person is feeling sick.

You may find it helpful to keep a range of different foods in the house so that you can offer them something at any time of the day. You may want to keep tinned foods and pre-prepared meals ready for when they feel able to eat. These foods can be as good for them as a meal that takes a long time to prepare.

If they can’t manage solid food, try soft foods such as porridge, bananas, custard, soup, yoghurt or milk-based foods such as rice pudding. You may try liquidised food or a nourishing drink, such as a smoothie. You can buy ready-made supplement drinks like Complan® or Build-Up® from your chemist and from some supermarkets. Other supplements are available on prescription.

Your GP, specialist palliative nurse or the dietitian may give you a supply of supplements before the person you care for comes home.

Moist food is often easier to cope with, and will help to prevent a dry mouth. A glass of crushed ice chips (flavoured or plain), or a bowl of ice cream can be refreshing and help to keep the person’s mouth moist. If their mouth or tongue is sore, drinking through a straw may help.

People with advanced cancer often take a long time to eat. Allow plenty of time so they don’t feel rushed. You may find yourself wanting to watch them eat if you’re concerned they’re not eating enough. This is understandable, but it can be off-putting to have someone watch what you eat. If they prefer, let them eat on their own. They can then eat what they want in their own time. If you have to feed them, make sure you’re sitting comfortably in a chair that gives proper support and allows you to reach them without stretching.

Eating in bed is often uncomfortable. If possible, make sure your relative or friend is supported with pillows, or in a chair next to the bed.

A table that goes across the bed can make eating easier. You may be able to hire one through the occupational therapist or home care team. Cushioned trays that sit safely on the lap or knees are another good way to make eating in bed easier and can be bought in a large home-store. A two-handed cup or a child’s feeder cup can be used for someone who finds it an effort to sit up or if their hands are weak or shake when they drink.

Mealtimes are often an enjoyable and important part of family and social life. It can be frustrating and worrying when someone you are caring for can’t eat very much and is losing weight. It’s normal for someone with advanced cancer to eat less and lose weight. Try not to take it personally if they can’t always eat what you’ve cooked, and don’t urge or nag them to eat as this can be unhelpful.

Nausea and vomiting

Some people with advanced cancer feel sick (nausea) or are sick (vomit). This may be due to the cancer or it may be a side effect of medicines or treatment. It’s important to let the doctor or nurse know if the person feels sick. There are anti-sickness medicines that may help. Some other tips to help relieve nausea and vomiting are:

avoid fatty and fried foods

eat cold foods as the smell from cooking and hot food can often increase feelings of nausea

eat small meals and snacks, and drink small amounts of fizzy drinks, such as ginger beer

Controlling pain

People with advanced cancer are often very worried that they are going to be in severe pain. But not everyone with advanced cancer will have pain. Of those who do, the pain can usually be well controlled with painkillers. Occasionally, some people may have pain that’s more difficult to control. In this situation, a combination of different medicines or other treatments may be needed.

The hospital doctor or GP will probably already have prescribed some painkillers. They are usually given as tablets or capsules that are taken by mouth. Some types of painkiller can be given as a patch stuck on to the skin (rather like a nicotine or hormone replacement patch). It’s also possible to give painkiller by injection just under the skin. Injections of painkiller are more likely to be used if a person can’t swallow or absorb tablets or capsules perhaps because they are being sick or are very drowsy.

If your relative or friend’s painkillers don’t seem to be working, contact their GP, district nurse or specialist palliative care nurse. An adjustment of dose or change of medicine may be all that’s needed.

Some painkillers can make people feel drowsy or light-headed at first, but usually this wears off after a day or so. If it doesn’t, tell their GP, district nurse or specialist palliative care nurse. It’s often possible to change to a painkiller that suits them better. Again, the painkillers can probably be changed.

You may be able to help relieve pain and discomfort with simple things. These include:

changing the person’s position

a heat pad or hot-water bottle wrapped in a towel to prevent burns

wheat packs that you can warm in a microwave

ice packs

massage.

Sometimes, just listening to the fears and worries of the person who is ill can help them cope better with pain.

If pain and other symptoms are very troublesome and distressing, a short stay in a hospice may help. In a hospice, the doctors and nurses will be able to assess their pain and symptoms. They can adjust the dose of medicines or add in new ones more quickly than if they were at home. Once their symptoms are controlled, they will be able to go home again.

Some types of pain can be controlled with more specialised techniques, such as a nerve block. If the hospice doctor thinks that a nerve block will help your relative or friend, they can refer them to a pain control specialist.

Managing pain during advanced cancer

Sleep problems

Your relative or friend may have problems sleeping at night. If they are in pain, it can be very difficult to sleep well and their pain control may need to be adjusted slightly.

They may be sleeping a lot during the day. If they are drowsy during the day and can’t sleep at night, ask their GP to check their medication. The GP may change their medicines to help them sleep better.

The person you care for may be anxious and find it difficult to relax. Reading, listening to music, meditating, or having a warm, milky drink or herbal tea in the late evening may help them to relax and fall asleep. Anything containing caffeine, such as coffee, tea and cola drinks should be avoided. The GP can prescribe sleeping tablets, if necessary.

Make sure that their mattress and pillows are comfortable, especially if they are spending a lot of time in bed. Ask the district nurse or occupational therapist if the person you are caring for needs a pressure-relieving mattress. You may be eligible for a Macmillan grant to help with the cost of buying a new mattress and pillows.

Here are some other ideas to help improve your relative or friend’s sleep:

make sure that the room is at the right temperature - cool with fresh air, but not too cold

have blankets available if needed

make sure there isn’t too much light – you could consider replacing the curtains for darker ones or putting up a blind behind the curtains to shut out more light

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